Press release
2025 Healthcare Fraud Detection Industry Trends Report: Long-Term Outlook Through 2034
Healthcare Fraud Detection
How Large Will the Healthcare Fraud Detection Market Size By 2025?
In recent times, the market size for healthcare fraud detection has witnessed a rapid expansion. Predictions show that it is expected to increase from $3.62 billion in 2024 to $4.67 billion in 2025, posting a compound annual growth rate (CAGR) of 28.9%. The substantial growth recorded in the historical period can be linked to factors such as heightened cyber threats, amplified emphasis on patient identity verification, intense market competition, improved identification of fraudulent claims, and an uptick in awareness and training.
How Big Is the Healthcare Fraud Detection Market Size Expected to Grow by 2029?
The market size for healthcare fraud detection is predicted to experience significant growth in the coming years, reaching $13.77 billion by 2029 with a compound annual growth rate (CAGR) of 31.1%. This growth during the forecast period can be ascribed to factors such as regulatory modifications, augmented digitalization, the complexity of fraud plans, emphasis on insurance fraud, and improvements in data security. In the forecast period, key trends will include the incorporation of advanced technology, real-time monitoring, behavioral analytics, the application of blockchain for enhanced security, and verification of patient identity.
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Which Key Market Drivers Powering Healthcare Fraud Detection Market Expansion and Growth?
The anticipated growth in the healthcare fraud detection market is largely due to the increased prevalence of fraudulent activity within the healthcare sector. Fraud within this sector is characterized by the intentional falsification of patient and insurance data, often with the aim of obtaining undue or unlawful benefits or denying a legitimate user of their rights. For example, it was reported by a UK financial institution in 2022 that there were 207,372 recorded cases of APP fraud that year, resulting in gross losses of £485.2 million, a decrease of 17 percent compared to the previous year. Such trends in fraudulent activity in the healthcare sector underscore the importance and prospective growth of the healthcare fraud detection market.
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Which Fast-Growing Trends Are Poised to Disrupt the Healthcare Fraud Detection Market?
The increasing use of sophisticated analytics tools is a prevailing trend in the healthcare fraud detection market. Major operators are directing their resources towards developing cutting-edge technologies to maintain their competitiveness in this market. For example, Premier, Inc., a healthcare technology firm from the US, launched INSights in January 2022 using PINC AITM technology. This vendor-neutral platform, Insights, utilizes risk-adjusted, standardized, and sanitized healthcare data from PINC AITM. It was developed to help healthcare providers decrease the burden linked to data processing and analytics creation for swift improvements in clinical, quality, and financial results.
What Are the Emerging Segments in the Healthcare Fraud Detection Market?
The healthcare fraud detection market covered in this report is segmented -
1) By Type: Descriptive Analytics, Predictive Analytics, Prescriptive Analytics
2) By Model: On-Premise Delivery, On-Demand Delivery
3) By Component: Services, Software
4) By Application: Insurance Claims Review, Payment Integrity
5) By End User: Healthcare Payers, Government Agencies, Other End-Users
Subsegments:
1) By Descriptive Analytics: Data Mining, Reporting Tools, Historical Data Analysis
2) By Predictive Analytics: Risk Scoring Models, Machine Learning Algorithms, Trend Analysis
3) By Prescriptive Analytics: Decision Support Systems, Optimization Algorithms, Scenario Analysis And Simulations
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Who Are the Global Leaders in the Healthcare Fraud Detection Market?
Major companies operating in the healthcare fraud detection market are International Business Machines Corporation, Cotiviti Inc., Fair Isaac Corporation, SAS Institute Inc., CGI Inc., DXC Technology Company, RELX Group PLC, EXL Service Holdings Inc., HCL Technologies Limited, UnitedHealth Group Incorporated, Conduent Incorporated, Change Healthcare LLC, OSP Labs LLC, Codoxo Inc., Wipro Limited, Qlarant Inc., Northrop Grumman Corporation, LexisNexis Risk Solutions Group, Healthcare Fraud Shield LLC, Sharecare Inc., FraudLens Inc., HMS Holdings Corp., H2O.ai Inc., Pondera Solutions Inc., FRISS B.V., MultiPlan Corporation, FraudScope Inc., McKesson Corporation, FraudGuard LLC, FraudCracker LLC
Which are the Top Profitable Regional Markets for the Healthcare Fraud Detection Industry?
North America was the largest region in the healthcare fraud detection market in 2024. The regions covered in the healthcare fraud detection market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa.
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